In elderly people, fracture of hip region is very common.
Very common predisposing factors are:
Loss of calcium from bones - this is due to -
(a) Lack of dietary calcium leading to osteoporosis- commonly people who are fussy about drinking milk.
(b) Lack of exposure to sunlight - elderly people avoid moving out in sun.
(c) Lack of exercise - general lethargy and lack of motivation to move out of house. Even normal walk maintains calcium in bones.
(d) Uncoordinated movements due to aging . They produce muscle imbalance and distribution of weight inappropriately.
Other causes are uncommon like abnormality of bone like -
(a) Cyst - a fluid filled cavity in bone
(b) Abnormal blood vessels causing thinning of outer part (cortex) of bone
(c) Tumour of bone
(d) Secondary spread of tumour from elsewhere.
What is a common presenting event before fracture?
1) Commonly a person in bathroom where water makes floor slippery is changing clothes with the weight of the body on one limb. This produces muscle imbalance and undue force causes fracture of hip region.
2) A person, standing in a room suddenly changes the direction to walk or twists. This also produces muscle imbalance and causes fracture.
3) Vehicular accidents can cause this type of fracture in relatively less aged population.
4) A fall from height can cause this type of injury.
What should alert one regarding this type of injury
1) A person is not able to stand, not able to bear weight of the body on limbs.
2) A person lies in bed with injured limb's foot touching bed. Outer border of foot touches bed and person finds it difficult to rotate foot inwards.
3) A person is unable to lift leg away from bed. Raising leg straight in air is impossible.
4) Pain in upper part of thigh.
5) Cannot go up to bathroom.
Usually in elderly people it is better to operate and fix the broken bone with screws and plates, because -
1) If they lie in bed for long, chances of respiratory infection are high. Because in lying down position lungs are not properly ventilated, the secretions in the lung continue to accumulate and provide appropriate environment for infectious agents.
2) Also blood movement in leg veins in lying down position becomes sluggish, this may cause blood clot in veins which can go anywhere.
3) The skin of the body which is in contact with bed for long time, like buttocks, area of back between shoulders, heels, near ankles also thins out due to the pressure and moisture and can break giving rise to wound called bed-sore.
In elderly precaution is required before operating like:
1) Haemoglobin in blood which carries oxygen from lungs to other body parts, should be normal.
2) Lung condition should be normal, because anaesthesia drugs and oxygen pass through lungs.
3) Heart condition should be alright because circulation maintains proper supply of oxygen and nutrients and also the bleeding which occurs during operative procedure should not affect circulation.
4) If diabetic, diabetes should be well controlled , because diabetics are more prone to blood pressure changes and adjustments of circulation of blood are less efficient in diabetics. Also wound healing of operative incision is bothersome. Chances of this wound infection are also more.